MEDICARE: WELLSPRING INTEGRATIVE HEALTH & ACUPUNCTURE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175F00000X	Naturopath
2	171100000X	Acupuncturist

General Provider Information

NPI Number	:	1639880149
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLSPRING INTEGRATIVE HEALTH & ACUPUNCTURE

Provider Business Mailing Address
First Line	:	101 ORETSKY WAY
Second Line	:
City	:	COTATI
State	:	CA
Zip	:	94931-5327
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	130 PETALUMA AVE STE 2E
Second Line	:
City	:	SEBASTOPOL
State	:	CA
Zip	:	95472-4234
Country	:	US
Telephone Number	:	707-492-5356
Fax Number	:	707-492-5349

Authorized Official
Title or Position	:	PRESIDENT, CEO
Name	:	DR. JAMES FIALK
Credential	:	L.AC, ND
Telephone Number	:	707-492-5356

Provider Enumeration Date	:	12/06/2022
Last Update Date	:	12/06/2022

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